First, I am not a scientist. I think I have a knack for making a logical picture of a situation. Those pictures are often usable, and sometimes completely wrong.
When the first mentions of this disease appeared in the press, there was much uncertainty. It started in a city in China’s interior. Not much was known about what was happening, but the measures looked draconian to Western eyes. Closing a metropole with 25 million citizens from the outside world. Shutting down most economic and social activities, first in the quarantined area, then in the whole country. For a disease with only a few dozen victims at first?
It sounded outrageous. In previous cases, China had been not very forthcoming with information, didn’t take effective measures, denied sometimes what was previously reported, and reported numbers that could be an order of magnitude too low. There was severe doubt about the accuracy of the news coming from China.
It appears that China did learn some lessons. The news was just a few days late. The numbers were probably accurate, or as accurate as they themselves knew them, and the measures were taken with the idea that you should better err on the side of caution.
A new virus is likely to escape even before it is discovered. The first warnings in this case were out in time. Understanding what the warning was about took too long, though. It was the same type of virus as the previous SARS and MERS outbreaks, but worse. On the opposite side, the best known variant of that virus type is known as the “common cold,” nothing to worry about. Some countries learned from the SARS and MERS outbreaks. Others did not. Most countries had their centers of infection show up before the organized responses occurred. Some countries did have epidemic response scenarios, while others treated it as the common cold. It was just a matter of time before we had an official full-blown pandemic declared by the WHO.
There were many questions at first. How contagious is it? What is the mortality rate? What is the incubation period? Will every infection result in illness? Is an infected person contagious before there are symptoms? Could there be large numbers of infected people spreading the disease that don’t have and perhaps never get symptoms? How many of the infected need hospital care? How many will need ICU care? What medicines are effective? Can a vaccine be developed? How long will it take to develop a vaccine? And many more questions, all important for one aspect of the pandemic or another.
What is of the most interest is the immediate future. For that topic, there are some questions and answers that are more important than others.
First question: Can it be contained? With both China and South Korea succeeding in containing it, that most important answer is a clear yes! China and South Korea even used different methods, something that is extra encouraging.
What is less encouraging is the failure in Western Europe and the USA to take those measures in time. China understood what was at stake and intervened. South Korea was prepared. Europe and the USA didn’t understand and were not prepared.
The result is that in the richest part of the world, in peacetime, the hospitals have to introduce the battlefield triage system for all patients. Will you survive without medical care? Go home and isolate yourself until you are healthy and the crisis is over. Are you going to die even with medical care? Sorry, go home and say goodbye to your loved ones.
Only those for whom medical intervention is a matter of life or death are accepted in the hospitals.
This picture is painted with a thick brush. The situation is more nuanced. But it is what a modern hospital in Northern Italy is essentially doing.
Second question: Can we identify who is infected? Yes, that is what South Korea and the Italian city of Vo have done. Test, identify, and isolate. This approach means you have to test many people, likely millions of people, some likely more than once. It is better than isolating the whole population for a number of weeks.
The self-isolation of the citizens of a number of countries is also effective. Nearly all infected persons will develop symptoms in 2–14 days. Outliers probably double that period. This is not a disease were there are many infected people without symptoms keep spreading the virus for weeks without getting sick themselves. If you don’t get symptoms, to be on the safe side, go self-isolate three weeks, even though you are likely not infected.
Children, especially the youth below 10, often don’t develop symptoms. Children do get infected at the same rate as grown-ups, and can spread the virus just like all other infected people.
Third question: How long will people be sick? If we start by counting the day they are infected, we see the virus is a lot longer than a common cold or a seasonal flu. The average incubation period is three times that of the flu. From first symptoms to recovery is 2 weeks for mild cases. From symptoms to death is 8 weeks for fatal cases.
Fourth question: How long will it take to contain the virus in a region? Looking at the timelines in both China and South Korea, it should be possible to contain the epidemic in 2 to 3 months with adequate measures. The critical word is “adequate.” There were many measures taken in the Western world, often with more concern for people’s daily routines, the economy, culture, and not putting a burden on the populace to help contain the virus.
The worst advice was probably by an Italian party leader, “not to change our habits.” He demonstrated what he meant in a photo of him in a bodega with a glass of wine in his hand during happy hour — excellent advice when the opponent is a terrorist group trying to derail your society, but deadly advice when the opponent is a highly contagious, deadly virus.
Europe started just last week with serious measures. With a lack of testing capacity, it was social distancing first, not going to work next, increasing gradually to house arrest in some countries now. Many people thought that staying home (shelter in place) was some kind of extra holiday. They went to the beach, the parks, shopping malls, and other destinations.
Now governments are closing businesses, like hairdressers, nail salons, clubs, bars, and restaurants. Police are starting to ask you why you are outside your home. IKEA and many like it closed their doors and sent their employees home. Others show less social responsibility, seeing lots of extra revenue coming to their stores.
Next came the closing of borders. The “no travelling” advice was ignored on a large scale. The top tourist destinations are the countries worst hit. It is easy to close old borders between countries, but it is harder to close regions within a country, like Italy has been doing for a while. When Italy got a national travel ban, the local bans stopped being enforced, with the predictable result of increased infections.
The USA should cancel at least 90% of domestic flights. You don’t want to see out-of-state license plates. A state like California should segment at least in North, Middle, and South California. Other large states like Florida and Texas should do likewise.
It is an illusion to think Europe or the USA will contain the spread of the virus as a country. The fight will be segment (country, state, region, province) by segment. A segment that has contained the virus, must stay free of the virus, by doing just like China and South Korea are doing now, not importing new infections from places that are not virus free. In other words, keep the borders closed to travelers from infected regions.
With severe measures on social distancing and house arrest in place in most of Western Europe, after about three weeks we should know who is infected and who is not. That is when the measures can switch from isolating everybody to isolating the infected. For all the infected, we need case workers to monitor their isolation and help organize day-to-day routines — providing things like shopping, getting medicine, taking out the trash, or other forms of care and support for such people.
The local economy can start again. For many businesses and products, new suppliers and logistic routes will be needed.
In places with less discipline from the public, or more lenient measures, this will take longer. Another two to three months later, the epidemic should be over.
Fifth question: Will it really be over? No. The virus is here to stay. Hopefully it will mutate to a less lethal variant. If it comes back in a more lethal form, we have to be prepared.
Just like in South Korea, all countries need to have a large enough stock of diagnostic equipment, drugs, and medical supplies. They all need tested disaster response plans.
After 9/11, the scrutiny of airline passengers increased. Now the scrutiny of all travelers will increase — likely less intrusive, but widespread. Making a business trip or going on vacation should not be risky.
Sixth question: Will the world be as before? Nope. We see the virus now only in countries with a highly developed medical monitoring system. Countries without those systems are not free of the virus, the cases are just not reported. When the body count rises in those places, we will hear from them. Just hope it will not be like that scene from Monty Python in which the daily body collection is filling their cart, with last night’s deceased.
To begin with, we must keep our borders with all the countries without a working monitoring system closed. Then those countries need support in building a modern healthcare and monitoring system. Problems that stay within a country’s borders are largely ignored by the international community. Border-crossing problems, especially those that cross into the industrialized world, must be solved for the benefit of that industrialized world.
International health organizations like WHO and national CDCs have been warning about the next big pandemic, a virus as virulent as the flu outbreak in 1918 but travelling faster and infecting more people than in that pandemic. SARS, MERS, and Ebola were not devastating enough to get through the skulls of many politicians that the threat is real. Perhaps this time the public and its leaders get the message.
Our own healthcare systems will be evaluated, both the primary medical system and the supporting social systems, like paid sick leave. We think of health care as an individual topic. Now we are confronted with the need to care for the health of our society. Those costs should be paid by society. Testing and forced isolation at home should not be individual costs.
Visiting the ER of a hospital should only be done in an emergency. The use of ERs by people who don’t have a family doctor is a failure of the medical system. The absence of the first line of medical care makes the second line prone to overloading in case of an epidemic.
Perhaps corona does not like the tropics, like tropical diseases are not widespread in temperate zones. We’ll see.
There was never a reason to develop a vaccine against the common cold. On the other hand, the memory of the Spanish Flu of 1918 made vaccination for influenza a high priority. Working vaccines and drugs against the common cold in all its variations could be the silver lining of this pandemic.
How long the coronavirus will keep your country, society, and economy in its grip is up to your politicians and the discipline of the public. Most could be back to normal within a month. Before the summer we should be able to celebrate the end of the pandemic in the industrialized world. With the (lack of) leadership in some countries, it will likely take a bit longer.